An Assessment of Medication Errors Among Pediatric Patients in Three Hospitals in Freetown Sierra Leone: Findings and Implications for a Low-Income Country

Abstract

Background

Pediatric patients are prone to medicine-related problems like medication errors (MEs), which can potentially cause harm. Yet, this has not been studied in this population in Sierra Leone. Therefore, this study investigated the prevalence and nature of MEs, including potential drug-drug interactions (pDDIs), in pediatric patients.

Methods

The study was conducted in three hospitals among pediatric patients in Freetown and consisted of two phases. Phase one was a cross-sectional retrospective review of prescriptions for completeness and accuracy based on the global accuracy score against standard prescription writing guidelines. Phase two was a point prevalence inpatient chart review of MEs categorized into prescription, administration, and dispensing errors and pDDIs. Data was analyzed using frequency, percentages, median, and interquartile range. Kruskal–Wallis H and Mann–Whitney U-tests were used to compare the prescription accuracy between the hospitals, with p<0.05 considered statistically significant.

Results

Three hundred and sixty-six (366) pediatric prescriptions and 132 inpatient charts were reviewed in phases one and two of the study, respectively. In phase one, while no prescription attained the global accuracy score (GAS) gold standard of 100%, 106 (29.0%) achieved the 80–100% mark. The patient 63 (17.2%), treatment 228 (62.3%), and prescriber 33 (9.0%) identifiers achieved an overall GAS range of 80–100%. Although the total GAS was not statistically significant (p=0.065), the date (p=0.041), patient (p=<0.001), treatment (p=0.022), and prescriber (p=<0.001) identifiers were statistically significant across the different hospitals. For phase two, the prevalence of MEs was 74 (56.1%), while that of pDDIs was 54 (40.9%). There was a statistically positive correlation between the occurrence of pDDI and number of medicines prescribed (r=0.211, P=0.015).

Conclusion

A Low GAS indicates poor compliance with prescription writing guidelines and high prescription errors. Medication errors were observed at each phase of the medication use cycle, while clinically significant pDDIs were also reported. Thus, there is a need for training on prescription writing guidelines and medication errors.

Keywords:

• pediatrics
• prescription
• medication errors
• drug-drug interactions
• Sierra Leone

Data Sharing Statement

The datasets analyzed in this study are available at https://doi.org/10.5281/zenodo.8185857.

Ethics Approval and Informed Consent

Clearance to conduct the study was obtained from the Research, Innovation, and Publication Review Committee of the Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone (RIPC-008-21). The management of the hospitals permitted the study to be done in their facilities. Informed consent was obtained from parents/caregivers after explaining the study’s purpose and procedures. Parents gave consent before data was collected and were not coerced to participate in the study. Patient information was coded and kept confidential.

Acknowledgments

We thank the management and staff at the study sites for their support in conducting this study.

Disclosure

We declare no competing interests.